Prevalence, profile of malnutrition and iron deficiency anemia in children with cyanotic congenital heart defects: a case control observational study in a tertiary care hospital in North India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20192033Keywords:
Anemia, Cyanotic congenital heart disease, Iron deficiency, MalnutritionAbstract
Background: Children with congenital heart disease (CHD) are prone to malnutrition. Children with cyanotic CHD [CCHD] are specifically affected due to chronic hypoxia and iron deficiency anemia which is overlooked by pediatrician. This can have a significant effect on the outcome of surgery. Our objective was to determine the burden and determinant of malnutrition in children with several types of cyanotic congenital heart disease (CCHD).
Methods: This case-control study included 80 children with symptomatic CCHD, and 40 healthy children matched for age and sex as a control group. Clinical evaluation and laboratory assessment of nutritional status were documented. Anthropometric measurements were recorded and Z scores for weight for age (WAZ), weight for height (WHZ), and height for age (HAZ) have been calculated. Haemoglobin, red cell indices and serum iron, total iron binding capacity and serum ferritin was done in cases and controls.
Results: The overall prevalence of malnutrition was 72.5% in patients with CCHD and 22.5% in controls. Severe malnutrition was diagnosed in 68.9% of cases. All anthropometric measurements which markers of nutritional state are were significantly lower in the patients group compared to controls. The prevalence of iron deficiency anemia (IDA) was 47.5% in the study population. The study also showed that hemoglobin and hematocrit levels, RBC count were paradoxically higher in the cyanotic CHD as compared to the healthy controls though the iron studies revealed the iron deficiency. The mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) mean corpuscular hemoglobin concentration (MCHC), serum ferritin, serum iron, total iron binding capacity (TIBC), values were the parameters, which were found to be statistically significant to differentiate the study groups.
Conclusions: Malnutrition is a very common problem in children with symptomatic CCHD, the prevalence of IDA in children with CCHD was found to be high.
References
Chen CW, Li CY, Wang JK. Growth and development of children with congenital heart disease. J Advanc Nurs. 2004;47(3):260-9.
Failure to Thrive: An update - American family Physician. Accessed at: http://www.aafp.org/afp/2011/040 1/p829.html.
Medoff-Cooper B, Ravishankar C. Nutrition and growth in congenital heart disease: A challenge in children. Curr Opin Cardiol. 2013;28(2):122-9.
Onur CB, Sipahi T, Tavil B, Karademir S, Yoney A. Diagnosing iron deficiency in cyanotic heart disease. Indian J Pediatr. 2003;70(1):29-31.
Gaiha M, Sethi HP, Sudha R, Arora R, Acharya NR. A clinico-hematological study of iron deficiency anemia and its correlation with hyperviscosity symptoms in cyanotic congenital heart disease. Indian Heart J. 1993;45(1):53-5.
Perloff JK, Rosove MH, Child JS, Wright GB. Adults with cyanotic congenital heart disease: hematologic management. Annals Int Med. 1988;109(5):406-13.
de Onis M, Blossner M. World health organization global database on child growth and malnutrition. Program of nutrition. Geneva:WHO. 1997.
WHO multicentre growth reference study group. WHO child growth standards based on length/height, weight and age. Available at: https://www.who.int/childgrowth/standards/Growth_standard.pdf.
WHO. Serum ferritin concentration for assessment of iron status and iron deficiency in population. Vitamin and Mineral nutrition Information system. Geneva WHO 2011.Accessed at: https://www.who.int/vmnis/indicators/serum_ferritin.pdf.
Varan B, Tokel K, Yilmaz G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Archiv Dis Childhood. 1999;81(1):49-52.
Mehrizi A, Drash A. Growth disturbance in congenital heart disease. J Pediatr. 1962;61(3):418-29.
Tokel K, Azak E, Ayabakan C, Varan B, Aşlamacı S, Mercan Ş. Somatic growth after corrective surgery for congenital heart disease. Turkish J Pediatr. 2010;52(1).
Vaidyanathan B, Nair SB, Sundaram KR, Banu UK, Shivaprakasha K, Rao SG, et al. Malnutrition in children with congenital heart disease (CHD): determinants and short-term impact of corrective intervention. Indian Pediatr. 2008;45(7).
Okoromah CA, Ekure EN, Lesi FE, Okunowo WO, Tijani BO, Okeiyi JC. Prevalence, profile and predictors of malnutrition in children with congenital heart defects: a case-control observational study. Archiv Dis Childhood. 2011;96(4):354-60.
Ratanachu-ek S, Pongdara A. Nutritional status of pediatric patients with congenital heart disease: Pre-and post-cardiac surgery. J Med Assoc Thailand. 2011;94(8):133.
Mukherjee S, Sharma M, Devgan A, Jatana SK. Iron deficiency anemia in children with cyanotic congenital heart disease and effect on cyanotic spells. Med J Arm Forces India. 2018;74(3):235-40.
Onur CB, Sipahi T, Tavil B, Karademir S, Yoney A. Diagnosing iron deficiency in cyanotic heart disease. Indian J Pediatr. 2003;70(1):29-31.
Olcay L, Ozer S. Parameters of iron deficiency in children with CCHD. Pediatr Cardiol. 1996;17:150-4.
O’Brien P, Smith PA. Chronic hypoxemia in children with cyanotic heart disease. Criti Care Nurs Clinic. 1994;6(1):215-6.
Lang'o MO, Gitchan'a JN, Yuko-Jowi CA. Prevalence of iron deficiency in children with cyanotic heart disease seen at Kenyatta National Hospital and Mater Hospital, Nairobi. East African Med J. 2009;86(12):47-51.
Kaemmerer H, Fratz S, Braun SL, Koelling K, Eicken A, Brodherr-Heberlein S, et al. Erythrocyte indexes, iron metabolism, and hyper homocysteinemia in adults with cyanotic congenital cardiac disease. Am J Cardiol. 2004;94(6):825.
Broberg CS, Bax BE, Okonko DO, Rampling MW, Bayne S, Harries C, et al. Blood viscosity and its relationship to iron deficiency, symptoms, and exercise capacity in adults with cyanotic congenital heart disease. J Am Coll Cardiol. 2006;48(2):356-65.
